I could call it a case, but really, this is my story. In the spring of 2003, I entered Iraq with a rifle and a side-arm. By the fall of 2003, I was walking into a classroom. Instead of worrying about snipers and dust storms and explosives, I was worrying about writing essays on Russian novels. I felt more nervous and awkward in the room of teenage students than I did months earlier in a foreign land in the dust-choked throat of war. I just knew they could see that I didn’t belong with them. I could feel them looking at me with guarded suspicion—the quiet guy in the front row—they knew I didn’t belong. While they had been comfortably enjoying their youth, I had bled and fought with fear and mortality. I didn’t resent them, but I partly wished I had their innocence and ignorance.
I quietly walked the halls and obsessively took notes in my classes, desperate to feel comfortable in this new setting and life. But I knew it was only a matter of time before I was exposed as an impostor. Certainly someone would announce to everyone that I was faking it: “He’s not a real student. He’s not one of us.” I felt they would be able to peek underneath and see the thoughts and experiences that I drifted to so often. The thoughts became a heavy blanket of security and comfort from the exposure that I felt.
The same thoughts and experiences separated them from me. The feel of the grip of my M-4 in my hand, my thumb brushing the safety. The deep penetrating rhythmic pulse of 50-caliber machine guns bursting in harmony. The smell of dirt and diesel and weeks-old sweat. The vivid realism of my thoughts gave me fleeting moments of normalcy within the distant isolation I felt.
In time, I settled in. This was largely by discovering that I was not alone. We discovered each other with an indoctrinated familiarity. Maybe the clue was a glimpse of a nylon belt or a matte-black knife in a pocket. The small things that all of us had that linked us to the life we had left. It wasn’t long before we were doing our own group therapy over pints of beers and war stories. Our shared experiences and our shared identity meant we did not have to be alone. Eventually our group expanded and formalized. We began doing outreach at vet centers promoting education and welcoming new student veterans to the campus. We attempted to use our individual experiences with the uncertainties of transition to create an environment of acceptance and understanding.
Leaving the military is not an easy or simple process. Like any major transition, it brings the stress of adjustment to new roles, relationships, routines, and assumptions.1 According to Schlossberg, it is not the transition itself that is important but the degree of change. The roles, relationships, routines, and assumptions within combat are unlike anything that a service member finds outside of the military. The degree of change that a combat veteran experiences while transitioning to civilian life is profound. The potential psychological stress of coping with such a change exposes one to the risk of significant adverse effects to health and well-being. To effectively direct interventions and support, attention should be placed on the factors that contribute to the transition, or transitions, as well as the factors that contribute to the ability to successfully adapt to the transition.
Adaptation to transition
Schlossberg has done extensive work on transition and adaptation to transition. She has offered a model for analyzing human adaptation to transition in her aptly named 1981 article, “A Model for Analyzing Human Adaptation to Transition.”2 I believe that her model offers guidance and insight to the combat veteran transitioning to civilian life. Her model can help identify the variables that affect transition and adaptation and, thus, guide treatment to minimize the potential effects of any psychological stress.
She defines a transition as “an event or non-event that results in a change in assumptions about oneself and the world and thus requires a corresponding change in one’s behavior and relationships.” Adaptation to transition is defined as “a process during which an individual moves from being totally preoccupied with the transition to integrating the transition into his or her life.”
Schlossberg’s model, drawing from a large body of literature on adult development, lays out 3 major factors that influence adaptation to transition (Table):
1. The characteristics of the particular transition
2. The characteristics of the pre-transition and post-transition environments
3. The characteristics of the individual experiencing the transition
She further states that the “ease of adaptation to a transition depends on one’s perceived and/or actual balance of resources to deficits in terms of the transition itself, the pre-post environment, and the individual’s sense of competency, well-being, and health.”2
Dr. Brown is currently a Fourth-Year Psychiatry Resident at the Naval Medical Center in San Diego, CA; he serves as the Chief Resident of the Consult/Liaison Service. The author reports no conflicts of interest concerning the subject matter of this article.
1. Schlossberg NK. Transitions: theory and applications. International Perspectives on Career Development. Symposium conducted at a joint meeting of the International Association for Educational and Vocational Guidance and the National Career Development Association; June 2004; San Francisco, CA.
2. Schlossberg NK. A model for analyzing human adaptation to transition. Counsel Psychol. 1981;9:2-18.
3. Tyler FB. Individual psychosocial competence: a personality configuration. Educat Psychol Measure. 1978;38:309-323.
4. Sayer NA, Noorbaloochi S, Frazier P, et al. Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatr Serv. 2010;61:589-597.
5. Hoerster KD, Lehavot K, Simpson T, et al. Health and health behavior differences: US military, veteran, and civilian men. Am J Prevent Med. 2012;43:483-489.